Rules for States Seeking Health Reform Waivers Announced

States could get exemptions from the Affordable Care Act -- provided they provide the same level of coverage.

The Obama administration today announced the steps states will need to take if they want to get waivers for parts of the health reform law.

Under a new set of proposed rules, a state can receive an "innovation waiver" that would allow it to implement health reform in a way that differs from the requirements of the Affordable Care Act (ACA), starting in 2017.

The plan is designed to improve flexibility for states as they implement health-care reform. But the waivers would only be granted if a state can provide coverage that is just as comprehensive and affordable as ACA's new health insurance exchanges. The state alternative must also cover as many people as ACA's plan.

States would also be required to maintain consumer protections that form the cornerstone of the law, even if they obtain a waiver.

The administration reiterated its support for legislation that has already been introduced to make the waivers available as early as 2014.

Some governors have opposed the rigidity of the health reform law, and to them, the waiver process could help alleviate their concerns. Mississippi Gov. Haley Barbour, for example, has complained that his state's own high-risk patient pool had 3,600 members, but the federal government's insurance exchange for his state would only serve 58 people.

The plan, released by the Department of Health and Human Services and the Treasury Department, was previously discussed with governors when they met with Obama at the White House last month. The administration has said the waivers could allow states to design programs that more aptly reflect their insurance markets, provider networks and residents' needs.

The proposed rules released today spell out the precise nuts-and-bolts of how states can obtain waivers, including how states should solicit public comments, the types of analyses that must appear in their applications and how the waivers will be evaluated.

The administration also offered examples of ways states could utilize waivers, such as changing benefit levels for plans offered in the exchanges, thereby giving consumers and employers more options.